COVID - Michigan's curve flattening?
After confirmed cases had been increasing in the neighborhood of 1500-1700 daily, yesterday 1376 new cases were announced and today, 1158.
This could be a reporting lag, but that tends to happen more on weekends. Wednesday/Thursday are generally not days when you see a drop. At this point we should start to see the effects of social distancing on the number of new cases. Henry Ford system officials are reporting that they are now discharging more patients than they are admitting to the ER. So there are some encouraging signs.
The curve of deaths is always behind that of cases though, so today was not good on that front (117) and we'll probably have more days of 100+ to come.
Also need to keep in mind that the overall #'s are skewed by Detroit and SE Michigan. So while those parts of the state may be seeing the curve start to flatten - which is something we all want to see - other parts of the state are likely behind and may see increases for a while. The same thing applies to our country as a whole. So as we start to see things change for the better in one area, there are going to be other areas where things are still getting worse. Let's keep all those people in mind.
I wonder if there's a small herd immunity starting in Detroit and New York, and Italy for that matter.
Someone smarter than me could dig into the population of people who would be likely to show symptoms (and get tested) vs. the total of those that are now infected. You might see that there's simply fewer people left to get infected that are over 50 or 60 say, for example. Don't know if that's 1% or 10% or what.
But yeah, I think in general, there's still room for rampant growth in other areas if they get a significant seed like Detroit did.
I am highly doubtful of any "herd immunity" at this time. There is no definitive proof one way or the other if you can get it again after you've already had it. There has been at least a few people worldwide that have become reinfected after recovery, though those could of course be outliers.
There are absolutely zero verified cases of people getting covid-19, being cleared of covid-19, and being reinfected with covid-19.
The reporting of these false re-infections is simply due to the nature of this virus. In many cases people who are infected and show moderate to severe symptoms start to feel better, even to the point of becoming asymptomatic, only to have the virus increase in intensity. While it may look like someone had it, got rid of it, and got it again, it’s simply not the case.
Even if there is no immunity to covid-19 after having it, reinfection most likely wouldn’t occur for a year or more. Most experts agree on this much.
I think I have read news stories about reinfection possibilities that turned out to be based on people that had tested as cured and then tested as infected later. The best medical hypothesis seemed to be that it was not a re-infection, but that the patient just had a sufficiently low spread of the virus in their system that the swab on the negative test did not happen to find any of it.
Per the Washtenaw County data, pretty much anyone (at least, any adult) can develop enough symptoms to warrant testing. The two largest age cohorts in the county are 50-59 (29% of county confirmed cases) and 25-39 (23%).
Where age starts to come into play is in hospitalization, where the rate goes up a lot beyond age 50.
Thanks for that. Translating to Detroit and doing quick math:
Detroit pop: 700K
pop under 18: 230,000
Detroit total cases: 6K
under 18 cases: 120
actual cases over 18? 24K?
over 18 population: 470K
percentage over 18 infected: 5%
There's obviously 2 assumptions here, that kids get it but don't get tested, and that of the people over 18, it's under-reported by 4k. i.e. people that are sick but just stay at home.
I seriously doubt it. Even if you make some aggressive assumptions like the 20k cases actually 4x higher due to lack of testing and asymptomatic people, and that all of them are in metro Detroit, that's still just 2 percent of the population.
Any decline will be because we're socially distancing, which also unfortunately means once we stop the cases may go up again.
See above for Detroit. I also think there's a lot of people that get sick but just stay home and ride it out.
In NYC, for example, they talk about potentially hundreds of people a day more than normal that have died at home that they don't count as COVID infected because they didn't test. That could mean several thousands of people a day in NYC get it but don't ever get tested.
I mean, how badly do you think we're under reporting cases? You need something like 100 unreported to 1 reported case to get anywhere near the bare minimum percentage you need for herd immunity (40%). It's just not realistic.
It's all related. If you increase the spread rate, you decrease the death rate. And vice versa.
If it's 5%, that's pretty significant IMO. That would change models. Need to get antibody testing for sure.
A recent poll of experts in which they were asked how many actual cases they thought there were compared to confirmed cases and the medium answer was that we're only confirmed 12% of cases which would mean there are about 8 times as many as have been confirmed.
Answers ranged as high as 100 to 1 though.
It's certainly possible. We don't know how many people are asymptomatic (most guesses are around 50% though which is a really high number). We don't know how many of those symptomatic people had mild symptoms that rode it out and never got tested. That could be a huge percentage as well. We don't even know how accurate our tests are. Some think up to a third of tests are false negatives.
We really don't know much yet. Even the antibody tests we're using to try to figure it our are very flawed (the thresholds are high so they're returning a lot of inconclusive or false negative results).
I see no way there is any sort of "herd immunity" developing anywhere yet. That requires something like 60-70% of the population to be infected, and recovered IIRC. We're not even close.
Yeah, herd immunity means it's died out. But it's not like an instant end; the more people immune the fewer people there are to get infected. I'm not sure where you'd start seeing that but it'd be way before 60%.
What about California? COVID-19 may have hit there in Dec-Jan. For a population of 40M plus, the infections are quite low. They should have been an epicenter.
If you have a better explanation, tell us.
I've posted my thoughts on this before, but I think it's not unreasonable to think 10-20% of the population has been infected:
(1) Today, there was a serology study out of Germany (the link is in German, but Google will translate) that suggest 15% of the population has been infected.
(2) Another serology study, 1-2 days before, out of Northern Italy, suggesting 13-14%.
(3) New York State is now at the point where 1 out of every 122 (!!!!) residents has had a confirmed positive test. That's 0.82%.
That's confirmed. The wildcard is the ratio between actual and confirmed.
Then consider (a) asymptomatics, (b) testing standards, that we're not testing anyone who is sick but only people who fit certain standards, and (c) children are especially unlikely to get sick or show symptoms, but there's no reason for them to be less likely to be carriers.
Based off the above, a number of academics are conjecturing the ratio between actual and confirmed is from 5x to as much as 30x.
Which would mean New York State's actual infection rate would be 4.1-24.6%. (5-30 x 0.82%).
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10-20% would not be "herd immunity." Herd immunity is thought to be 60-70% for this virus. But 10-20% is a non-insignificant chunk of the way there. It would help to dampen the effects of a 2nd, 3rd, etc wave.
You seem pretty knowledgeable on this topic and I enjoy reading your posts so I'll ask you: have you read or seen anything else lately about how early the virus may have been in the U.S.? I know there were some doctors and scientists who think it may have been spreading earlier than we initially thought.
If it turns out it may have been circulating in December or even November then its possible the herd immunity could be even higher, right?. But at the same time we won't really know until extensive antibody testing is done, right?
Around Xmas I got pretty sick, something I'm pretty sure I picked up in LaGuardia or on my layover in Minneapolis. It hit hard a few days before xmas and then lingered for more than a week. My mother got it worse than I did, with a much more persistent and painful cough and then my girlfriend got something similar in January when I returned home. It was most likely a nasty chest cold but I'm curious nonetheless because it was so unusual (but from what I understand about covid, my mother, 68yo with asthma, would likely be a goner if she contracted it).
If it had been circulating in November / December at least a handful of people would've wound up in the hospital with the COVID-19 suite of symptoms.
Exponential growth is a really powerful thing which cuts two ways.
5 doublings- 32 cases
10 doublings - 1000 cases
‘
15 doublings - 32000 cases
20 doublings - 1 million cases
at 32000 cases, even a 2% mortality rate is only 640 deaths. If they were spread out geographically they could just be chalked up to the flu. On the other hand, 32,000 cases spread across the country also makes it unlikely that multiple people on this board had cases.
also, early in US deaths were doubling every three days which suggests infections were doubling at a similar rate. Even if you assume 10% of US population was infected March 15, that only means 25 doublings (75 days). That math makes it hard to have a first infection in November or December.
My special needs son who is vulnerable due to respiratory problems was hospitalized 3 times this winter, and at least 2 of those times did not test positive for the flu.
December 11 - 6 days in the pediatric ICU in Grand Rapids
January 2 - 1 day at Lurie Children's Hospital, Chicago
Feb 1 - 2 days again in Grand Rapids.
We are pushing pretty hard to get the antibody test for my family of 4.
User name checks out. Good luck with your son Dutchman.
They're nearly certain from sequencing the virus that the Detroit (and I think NYC) outbreak came from Italy, which means late February.
It's not impossible, but really really unlikely.
If you look at deaths per capita, New York at 360 per million, is more than 7 times the national average of 50 per million. If the ratio of actual cases is similar, even if 70% of New York had been infected, that would imply only 10% on average for the rest of the country. More than half the states are below 25 per million which would suggest many states are well below 5%.
You would have very small herd immunity numbers if you base the number on the US population. Even if you multiply our cases by ten or twenty times, you are only talking about a few percent of the population. That makes this disease ripe for another round or two unless/until we have a vaccine or cure.
FWIW, Spain and Italy may have had at least 10 percent of their populations exposed.
Some years, we have 40-80 million people contract influenza. Check out Table 1 from this link: https://www.cdc.gov/flu/about/burden/index.html
I was thinking localized area like Detroit, and basically people over 18. I did the quick math above, but in Detroit for people over 18, basically 1% have tested positive.
If you go 10-20x that it gets real high. I think 2x-4x is more likely.
They are projecting that in Spain 15% of the population has been exposed to covid-19 so herd immunity might be closer than we think. The key is keeping the weakest safe so we should be quick to keep 65+ quarantined for a while even while the rest of us go about building it up.
Do you have a link as regards that 15% Spain number?
I'm sure you're right, I'd just love to read and research it more. Thanks in advance!
I do....in a chart on page 6 of this report from the Imperial College of London.
https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020-03-30-COVID19-Report-13.pdf
Here's a link to the summary: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-13-europe-npi-impact/
Note the band of potential infections ranges from 3.7% to 41% potentially for Spain.
I’m not sure about the 15% figure for Spain but even if true, that would still leave them a long way to go to herd immunity - and they’ve paid a steep price to get to whatever percentage they have now. 15,000 deaths in Spain is the per capita equivalent of over 100,000 in the U.S. I don’t see pursuing a herd immunity strategy as the way to go here.
For a country with 47,000,000 people, 15,000 deaths is not that many. Especially when you consider they average 40,000 deaths a month in any given year.....
I feel for those people and their family members but 15,000 deaths over 2-3 months is not enough to justify the ruination of millions. Especially when the median age of death is 80!!
https://elpais.com/sociedad/2020-03-22/radiografia-por-edades-del-coronavirus-en-espana.html
Italy's average was 79.4 at one point. As much as we don't want to hear this, an awful lot of these deaths that are Covid related would have happened in the next bad Flu season.
Pure top of the head thought. I wonder if flu vaccines are keeping the more fragile older people from getting the flu, causing them to stick around a few more years than they would have otherwise, only to get wiped out by Covid 19. That stinks.
We are clearly never going to agree on this point, but the issue is not just about the number of dead people. It is about keeping our medical system from getting overwhelmed. I hope that you would agree that the situation in NYC is pretty severe?
Even if we focus just on deaths, there have been over 4700 deaths attributed to Covid with over 500 in the last 24 hours. On average, about 150 people usually die in a 24 hour period in NYC. These counts are low because NYC is not counting deaths that happen at home. ‘The FDNY says it responded to 2,192 cases of deaths at home between March 20th and April 5th, or about 130 a day, an almost 400 percent increase from the same time period last year.” https://gothamist.com/news/surge-number-new-yorkers-dying-home-officials-suspect-undercount-covid-19-related-deaths. As has been widely reported in the news, both hospitals and EMS is overwhelmed. This is what the stay at home orders are meant to prevent in other places. I think you would agree that if other places were having 3 to 4 times as many people dying every day, the economy in those places would not be running like normal?
I agree this is done to keep the medical system from being overwhelmed....and I think that's a reasonable thing to do in the sort term. However, the only hospital that was overwhelmed in NY was Elmurst and that was for a short time. I have family who are physicians in the city and they are telling me their hospitals (NYU Langone/Bellevue and LIJ) are ok and are not to capacity. Most hospitals are projecting they will not be overrun and have extra beds and ventilators currently. De Blasio came out today saying the city will not need anymore ventilators or beds:
https://nypost.com/2020/04/08/de-blasio-nyc-only-using-fraction-of-ventilators-of-what-was-expected/
We are through the worst of it in every major cities and hopefully it stays that way.
Now it's on to Phase 2 - need to get herd immunity in the young and healthy.
You might want to google NYC hospital overwhelmed
a few links for you
At Brookdale University Hospital Medical Center in New York, the ICU is at capacity, patient beds line the hallways of the emergency department, and the morgue is overflowing.
Covid-19, Dr. Arabia Mollette said, has turned the Brooklyn-based hospital into "a war zone."
https://www.cnn.com/2020/03/30/us/brooklyn-hospital-coronavirus-patients-deaths/index.html
The measures that NYC hospitals have taken to extend capacity and care for critically ill Covid-19 patients are extreme and unprecedented. Hospitals have begun to convert pediatric units into adult ICU rooms, transferring the children who previously occupied those rooms to other hospitals. Operation rooms previously reserved for surgery – left vacant in the wake of cancelled elective procedures – have also been converted to ICU rooms at many hospitals.
https://www.vox.com/2020/3/27/21197400/new-york-covid-19-hospitals-coronavirus
It does sound like the situation in NYC is severe. I would agree. Thankfully we have a nation that stretches from sea to shining sea, rather than just the NYC metro area. And as I work in the hospital industry, I can tell you the rest of the nation would gladly, gladly!, pick up the slack if asked. If NYC is/was seriously overwhelmed they could/can send patients elsewhere.
Hundreds of hospitals across the country are laying off people to conserve cash right now. We, quite properly, are not doing elective procedures, conserving medical supplies. There is plenty of space, this isn't Italy.
I don't believe Covid 19 deaths are under-reported. There is no incentive to do so. In fact, there is an incentive to over-count for attention. But I don't have any idea whether that's the case either. Coronavirus, like the Flu doesn't actually kill you. It enables something else to kill you. It usually comes down to money. What codes pays better if everything is true? Outside a hospital, it's usually what involves the least paperwork. Humans are human.
You raise a great point. Though we are staring our own anti-body testing in the US (believe Gates Foundation is funding), Germany is already well on the way. They are testing nationally but the first city with results of random testing found nearly 15% were carrying antibodies to the virus. Considering that Germany has not been near the infection level of New York or Italy, I could see those places already pushing over 1/3 of the population with anti-bodies. And, I don't think it is a dangerous jump to conclude those anti-bodies will provide at least a year or 18 months of immunity or high-resistance to the virus. Hopefully enough time to see a vaccine or stronger medicinal treatments.
Hold on. First, Germany is reporting 115,000 cases so it's not like they haven't been hit by this. Second, that 15% figure comes from just one town in Germany, not the entire country. To extrapolate from a single German town that a third of New Yorkers or Italians are immune is a bit of a reach.
Germany has made it a mission to track every contact for Covid. They determined/suspect one of the very 1st cases contracted Covid sharing a salt shaker at lunch with a colleague. They have isolated and contacted people with vigilance. It’s the German way.
if we are referring to Gangelt, it was also one of the hardest hit areas in Germany. They also calculated a fatality rate of a bit under 0.4%. If one assumes this in NY, that would mean approximately 1.75 million infected or about 21% of the population.
If you apply it to Michigan about 275,000 infected or a bit less than 3% of the population
If you apply it nationwide about 4,175,000 infected or about 1.3% of the population.
For reference CDC estimates that somewhere between 5% and 20% of people get flu each year in the US. https://www.singlecare.com/blog/flu-statistics-infographic/
"small herd immunity" is not a thing
No shit, but sometimes using terms people are familiar with as a starting point gets the point across more clearly.
This blogpost from 538 makes the point that it’s not just old people we are doing this for.
According to the data, more than 135 million American adults, or 52 percent, are somehow at elevated risk.
- About three-fifths of those who are vulnerable are under 65.
Although everyone over 65 is considered to be at higher risk whether or not they have underlying conditions, as you can see in the chart below, more than 30 percent of every age group is at risk. Overall, nearly 40 percent of all Americans under 65 have a condition that makes COVID-19 more dangerous for them.
Hospitalization and death rates plummet once you go below age 65, though, so I would argue we ARE just doing this for old people.
For Colorado: 150 of 193 deaths are aged 70+....tack on aged 60+ and its 170 of 193 deaths: https://covid19.colorado.gov/case-data
NYC follows a similar pattern: https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-daily-data-summary-deaths-04092020-1.pdf
From the article I linked that you are disagreeing with
”A recent report from the CDC found that as of March 28, only about half of all patients hospitalized with COVID-19 were over 65, while three-quarters of hospitalized patients of all ages had at least one underlying condition.“. So you can argue that it is only about old people and I will respectfully disagree.
Sure....but if 50% of cases come from 15% of the population (50mm people aged 65+ out of 330mm), I would say the data skews heavily towards that particular population - in the case the elderly.
One could also argue it's the elderly AND the infirm, given the 75% having an underlying condition, but there's a lot of overlap there as well, I'm sure, as you don't get to be aged 65+ without some kind of underlying condition.
Taking JUST the elderly out, saves 50% of hospital capacity. That's where we should start.
If you can magically assume there is a way to truly isolate the elderly. Some nursing homes have been hit pretty hard, someone is bringing them food even if they don’t live in a nursing home etc. while this is certainly the way we are going to have to go, I don’t think it is as easy as you suggest.
Given that the entire state has been under the stay-at-home order for two weeks now, I think if we were going to see a big outbreak in a place like Lansing or Grand Rapids it probably would have happened already. Michigan's overall numbers will probably continue to be driven by Metro Detroit's.
For the U.S. as a whole, it's harder to say, given that states have handled this differently.
Yep, as the cities that are getting hit hard right now get better, other cities, especially in the South where they're not taking this seriously, will get worse
Yeah, we’re at 3 deaths in Grenville County. If this thing doubles watch out. It will actually be worse than an average car crash. Good thing we didn’t overreact and spend $3 trillion and push the country into a depression.
Ironically we used communism to avoid the depression (so far)